If you’re interested in using your SoonerCare to obtain treatment for a drug or alcohol addiction, it’s important you understand the full extent of your coverage, so you can best use it to your advantage to build a sober life.

What Is SoonerCare?

SoonerCare, Oklahoma’s Medicaid, is administered by the Oklahoma Health Care Authority (OHCA). Funded by both the state and Federal governments, this health coverage program provides assistance, either in full or part, for medical bills for those in need.

Coverage is provided for doctors visits, hospitalization, prescriptions, and, in certain cases, behavioral healthcare, including those services required for the treatment of a substance use disorder (SUD). These services extend to U.S. citizens or qualified aliens, residing in Oklahoma, who meet certain requirements, including established income guidelines.

SoonerCare health coverage is offered through both SoonerCare Traditional and SoonerCare Choice. A brief explanation of services is as follows:

SoonerCare Traditional: According to the OHCA website, “Traditional fee-for-service SoonerCare has a statewide network of providers that includes hospitals, family practice doctors, pharmacies and durable medical equipment companies.” In order to receive SoonerCare assistance, services must be obtained at a SoonerCare provider, a fact which should be considered prior to seeking treatment for a SUD.

SoonerCare Choice: The OHCA explains that “SoonerCare Choice is a Primary Care Case Management (PCCM) program in which each member has a medical home. The medical home provider will coordinate all health care services to qualifying Oklahomans.” Like SoonerCare Traditional, we recommend that you examine your coverage before committing to a treatment provider.

The OHCA also offers SoonerCare Supplemental, a Federal health insurance program that helps some individuals pay for their Medicare cost sharing requirements, including such services as Medicare Part A, B, and D. Our treatment specialists can help you to determine if these benefits can assistance you in obtaining substance abuse treatment services.

Does SoonerCare Cover The Cost of Outpatient Substance Abuse Treatment?

Outpatient treatment for a substance use disorder may be provided by your SoonerCare Medicaid health coverage benefits.

The Oklahoma Health Care Authority writes that all Outpatient Behavioral Health Centers provide a mental health assessment. This is especially important in instances of substance abuse and addiction, as mental illnesses frequently accompany addiction (termed a co-occurring disorder or dual diagnosis). In recognizing this, and treating it accordingly, an individual has a higher likelihood of long-lasting success.

The OHCA notes that Outpatient Behavioral Health Centers are “those contracted by OHCA as private outpatient providers and those contracted by the Department of Mental Health Substance Abuse Services (ODMHSAS) as Community Mental Health Centers and by OHCA.”

Outpatient care, though not appropriate for every individual, does have an important role within treatment, especially as a “step down” service. After an individual has successfully completed an inpatient rehabilitation program, an outpatient program can help them step down, or transition, into sober living.

Does SoonerCare Cover The Cost Of Treatment At An Inpatient Rehab Center?

Every state determines the exact benefits and coverage of their Medicaid program, and in the instance of SoonerCare, according to a benefit comparison, residential substance abuse treatment is not covered, either for adults, or for those children under 21. The OHCA does note, in regards to residential substance abuse services, that detoxification only is covered by Medicaid.

But if you’re in need of treatment for drugs or alcohol, don’t let this stop you from seeking the help you need. A variety of options exist beyond paying out of pocket and insurance coverage, including scholarships and grants, sliding fee scales, and financing options, among others. We can help you to examine these and more as we build a treatment plan together.

Residential inpatient drug rehabilitation programs, though generally more expensive and time consuming, typically provide more comprehensive care, especially for those facing severe addictions, such as to alcohol, benzodiazepines, or opioids, including heroin and prescription painkillers.

Though choosing an outpatient program may save you time and money in the short term, it may only serve to consume far too much of both of these things in the long run. The National Institute on Drug Abuse notes that 3 months of treatment is the minimum most people require to cease using drugs. Without the proper treatment, a person may not be able to overcome an addiction.

Should a person continue using alcohol or other substances, the cost, both financial and to a person’s life and health, will continue to add up. The greatest price could be a loss of life; continued substance abuse means that a person could overdose and lose their life.

If you’re in need of detoxification, consider choosing a facility which offers both medically-supervised detoxification and rehabilitation services under one roof. Doing so grants a person a more stable experience as they move from one service to the next.

Does SoonerCare Cover the Cost of Suboxone?

Suboxone is combination medication of buprenorphine and naloxone which is widely used within medication-assisted treatment.

In Oklahoma, SoonerCare beneficiaries may require a prior authorization before obtaining this medication for use during treatment. Suboxone is listed as a preferred product, however, Bunavail and Zubsolv may be authorized, should a “a patient-specific, clinically significant reason” be present.

A prior authorization means that a person’s doctor must obtain permission before they’re able to prescribe the drug. To do so, certain documentation must be provided, including that which details a diagnosis of opiate abuse/dependence. Once this occurs, SoonerCare may pay for the medication, with an approval possibly lasting 90 days.

Suboxone can be of great benefit during a medically-supervised detoxification, due to the way it reduces cravings and withdrawal symptoms. When supported by therapy and counseling, this medication can help a person to stabilize so that they’re able to focus more fully on the next stages of their recovery.

Does SoonerCare Cover the Cost of Methadone Maintenance?

Currently, methadone is not listed within OHCA documents pertaining to prior authorizations of medications for substance abuse treatment. However, this does not mean that in the future it won’t be available, as policy regarding substance abuse is constantly changing on a state-by-state basis.

If you’re interested in a program that offers methadone maintenance, we can help you to find other treatment options.

Finding A Rehab Center That Accepts SoonerCare

As you’re pursuing treatment, it’s important to consider the unique needs of yourself or your loved one against what each program offers. Every person facing addiction is different, and for this reason, treatment should be tailored to each individual’s life.

This individualized treatment commonly includes medications, behavioral therapies, and a variety of other treatment methods. Therapy and counseling may be offered in an individual, group, and/or family setting, allowing a person to heal on each level within their life that is affected.

Contact RehabCenter.net today to learn more about addiction treatment.

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